The prevalence of pre-analytical errors in the laboratory of the Cantonal Hospital Zenica in Bosnia and Herzegovina

Aim To identify rates of most common pre-analytical errors and to document possible (different) error rates between inpatients and outpatients. Methods This retrospective study was conducted at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from December 2016 until March 2017. Data on rejected blood samples in the laboratory information system were analysed. Results During the 3-month period 35,343 patient blood samples (25,545 inpatients and 9,798 outpatients) were received in the laboratory. The study identified 602 (1.70%) rejected samples because of pre-analytical errors, mostly due to haemolysis, 292 (48.50%), and clotted samples, 240 (39.87%). The remaining 70 (11.63%) samples were rejected because of inappropriate sample volume, inappropriate container and identification errors (7.81%, 2.16% and 1.66%, respectively). The proportion of inpatient rejected samples was 8.7-fold higher than in the outpatient samples. The proportion of inpatient rejected samples because of haemolysis, clotted samples, inappropriate sample volume and inappropriate containers were higher than in the outpatient samples (20.5-, 12.1-, 2.3- and 1.3-fold higher, respectively); proportion of rejected samples because of identification errors was 8.0-fold higher in the outpatient (collection sites outside the hospital) than in the inpatient samples. Conclusion Higher pre-analytical sample error rates were connected with inpatient samples, while higher identification error rates were connected with outpatient samples. Establishment of periodic stuff training and introduction of information technology could reduce pre-analytical errors

Fasting state requirements for blood sampling: a survey of patients in Cantonal Hospital Zenica, Bosnia and Herzegovina

Aim To explore patient’s awareness and appliance of the fasting state requirements for blood sampling. Methods This observational survey was performed at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from June to July 2019. An anonymous questionnaire was conducted on 200 consecutive outpatients older than 18, who were admitted to the laboratory for routine blood testing. Results A total of 134 (67%) patients were informed that they needed to be at fasting to perform laboratory tests. Patients were mostly informed by a requesting physician or a nurse, 68 (50.8 %), and by other patients, members of the family and friends, 58 (43.3%); only seven (5.2%) patients were informed in the laboratory. A total of 75 (37.5%) patients arrived to the laboratory properly prepared. Conclusion Most patients were not well informed about fasting state requirements for blood sampling and consequently they were not adequately prepared for laboratory tests. Laboratory should establish updated fasting recommendations available to patients and healthcare professionals, and conduct continuing education of patients and health care staff

Poikilocytotic forms caused by hyperthermia and heat stroke- experimental study on Wistar rats

Background: The aim of the study was to find out what happens to erythrocytes and their forms during life and after death as a result of high water temperature.Methods: Heat stress was used on a rat model.to investigate the effects of different temperature intensities (37°C and 44°C) and exposure time (20 min and until the time of death) on erythrocyte morphology. Total of 23 Wistar rats were divided into two groups: 37°C as control group and 44°C as trial groups. The trial groups were classified into antemortem the exposure time of 20 min and postmortem groups exposure time until fatal outcome. The anaesthetised rats were exposed to preheated water using the water bath. May-Grünwald-Giemsa colouring technique was applied on blood samples taken from the abdominal aorta. Results: Exposure of Wistar rats to water temperature in groups KG37 and G44 led to a significant changes in core temperature. In the control group, the thermoregulatory mechanism established normothermia, and in G44 hyperthermia was detected during 20 minutes of exposure. The frequency of heat stroke in group G44 was 43.8%. Target cells and anulocytes were predominant in antemortem group at 44°C, while anulocytes and spherocytes in postmortem groups 44°C, respectively. Dacryocytes with spherocytes were significantly higher in postmortem group 44°C than in antemortem group 44°C (p=0.002, p=0.017, respectively).Conclusions: Poikilocytosis is associated with the exposure length and temperature intensity. Following a fatal outcome dacryocytes with spherocytes at 44°C were significantly more than in corresponding antemortem groups

The importance of plasma ferritin values in blood donors for the evaluation of body iron store in a five-month period

Aim To present haemoglobin and ferritin parameters in donors to highlight the importance of serum ferritin testing for the purpose of evaluating iron depots in order to make recommendations for preserving a population of blood donors. Method A prospective study was conducted on 80 blood donors divided in two groups: group I (regular donors, n =40) and group II (irregular donors, n=40). Haemoglobin and ferritin were measured twice every 45 days, before two consecutive blood donations. Results By measuring haemoglobin and ferritin values before donation in both groups, a decrease of initial ferritin value in Group I relative to Group II was observed (without statistical significance). A significant decrease was found between repeated measurements for both parameters in both groups, indicating equal intensity of the decline in value regardless of a donor status. Measurement of ferritin before and after donation revealed statistically significant loss of ferritin in all examinees (p=0.011). The decline in haemoglobin after donation, although significant, did not fall below the reference value for donation in either women or men. Conclusion Results indicate the need for periodic monitoring of the plasma value of ferritin in voluntary donors who donate blood more than twice a year and the possible oral supplementation with iron

Brain and serum beta-endorphin concentrations in trazodone treated rats

Uvod: Beta (β) endorfini otkriveni su u hipotalamusu i hipofizi, a u manjoj količini i u drugim organima. Cilj ove studije bio je utvrditi mogući utjecaj psi-hotropnih lijekova na β-endorfine u serumu i mozgu kod štakora kao eksperimentalnog modela. Materijal i metode: Studija je provedena na albino Wistar štakorima (200-250 g tjelesne težine) uz primjenu antidepresiva trazodona. Tehnika RIA primijenjena je za kvantificiranje β-endorfina u serumu i mozgu. Rezultati: Koncentracije serumskih β-endorfina izmjerenih 1. dana primjene trazodona bile su značajno više (72,3 ± 1,86 pg/mL; x ± SEM) od početnih koncentracija (45,83 ± 3,77 pg/mL; P = 0,001). Međutim, trazodon je doveo do značajno nižih koncentracija β-endorfina 9. dana liječenja (33,4 ± 1,91 pg/ mL) u usporedbi s koncentracijama izmjerenim 1. dana davanja lijeka (P = 0,001). Koncentracije zabilježene 28. dana (38,62 ± 1,42 pg/mL) bile su više u usporedbi s onima izmjerenim 9. dana (P = 0,439). Koncentracija β-endorfina u mozgu pokazala je značajno sniženje 1. dana davanja trazodona (431,03 ± 11,57 pg/g) u usporedbi s kontrolnim životinjama (873,5 ± 18,32 pg/g; P = 0,001). Usporedba nižih koncentracija zabilježenih 9. dana liječenja (433,65 ± 14,67 pg/g) i onih u kontrolnoj skupini životinja također je dala statistički značajne vrijednosti (P = 0,001). U skupini životinja na trazodonu 28. dana su koncentracije β-endorfina u mozgu bile značajno više 28. dana (929 ± 18,13 pg/g) od koncentracija izmjerenih 1. i 9. dana (P = 0,001 oboje) liječenja, i te su koncentracije bile više od onih zabilježenih u kontrolnoj skupini, međutim, bez statističke značajnosti (P = 0,137). Zaključak: Kronično liječenje trazodonom uzrokuje porast sinteze β-endorfina u mozgu, dok akutno davanje ovoga lijeka dovodi samo do brzog oslobađanja β-endorfina u krvotok.Introduction: Beta (β) endorphins have been detected in the hypothalamus and pituitary, and in a small amount in other organs. The aim of our study was to establish the possible influence of psychotropic drugs on serum and brain β-endorphins in rats as experimental model. Material and methods: The study was performed on albino Wistar rats (200-250 g body weight), using the antidepressant trazodone. RIA technique was employed for quantification of serum and brain β-endorphins. Results: Serum β-endorphins measured on day 1 of trazodone application were significantly higher (72.31 ± 1.86 pg/mL; x± SEM) compared to baseline values (45.83 ± 3.77 pg/mL; P = 0.001). However, trazodone produced significantly lower β-endorphin concentrations on day 9 of treatment (33.4 ±1.91 pg/mL) compared to the values measured on day 1 of trazodone administration (P = 0.001). Endorphin concentrations recorded on day 28 (38.62 ± 1.42 pg/mL) were higher compared to those measured on day 9 (P = 0.439). Data on brain β-endorphin concentration showed a significant decrease on day 1 of trazodone administration (431.03 ± 11.57 pg/g) compared to data obtained from control rat brains (873.5 ± 18.32 pg/g; P = 0.001). Statistical significance was also recorded by comparison of the lower data obtained on day 9 of treatment (433.65 ± 14.67 pg/g) and those observed in the control group (P = 0.001). In trazodone treated rats, brain β-endorphins were significantly higher on day 28 (929 ± 18.13 pg/g) compared with the levels measured on day 1 and day 9 of treatment (P = 0.001 both), showing slightly higher values than in control rats, yet without statistical significance (P = 0.137). Conclusion: Chronic trazodone treatment causes an increase in the brain β-endorphin synthesis, while acute drug administration results only in a rapid release of β-endorphins into the circulation

High-density lipoprotein cholesterol, apolipoprotein E and atherogenic index of plasma are associated with risk of chronic kidney disease

Aim To investigate the association of parameters of lipid profile and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 calculated by the Modification of Diet in Renal Disease (MDRD) in non-dialysis kidney patients. Methods The observational, case-control study enrolled patients (n=117) recruited from the Nephrological Counselling Centre of the University Clinical Centre Sarajevo and divided into two groups: group 1 eGFR (15-59 mL/min/1.73 m2), and group 2 (control) eGFR ≥ 60 mL/min/1.73 m2. Concentration of lipids, lipoproteins and apolipoproteins was measured, and atherogenic index of plasma (AIP; log(TG/HDLc)) was calculated. Results High density lipoprotein cholesterol (HDLc) and apolipoprotein E (APOE) concentrations in serum were reduced [(1.02 (0.94-1.29) vs 1.15 (1.1-1.4) mmol/L; p=0.009 and 0.035 (0.026-0.04) vs 0.041 (0.034-0.05) g/L; p=0.002, respectively)], while AIP was higher in group 1 than in group 2 (0.19±0.03 vs 0.09±0.04; p=0.013). Values less than 1.09 mmol/L and 0.038 g/L for HDLc and APOE, or higher than 0.165 for AIP (p<0.05) were associated with the eGFR below 60 ml/min/1.73 m2. The age [OR = 1.1; 95% CI (1.05-1.17)] and AIP [OR = 8.7; 95% CI (1.18-65.0)] were independent positive predictors, while APOE was a negative predictor of eGFR reduction rate (OR=0.01; 95% CI (0.001-0.033; p<0.001). Conclusion Changes in parameters such as HDLc, APOE and AIP are associated with CKD. The study results imply the need of the AIP calculation as routine laboratory work due to its role along with the age and APOE in the prediction of renal function decline

B-type natriuretic peptide and adiponectin releases in rat model of myocardial damage induced by isoproterenol administration

B-type natriuretic peptide (BNP) and adiponectin play important role in the cardiovascular homeostasis regulation. We investigated BNP and adiponectin serum levels followed by isoproterenol (ISO) administration to rats and explored the relationship between them. Cardiac troponin I (cTnI) blood level was used as biochemical evidence of myocardial damage development. Adult male Wistar rats (average body weight 273.33 ± 21.63 g) were distributed into groups: control group received saline (n=6) and ISO groups (n=12) treated with ISO (subcutaneous single dose 100 mg/kg of rat body weight). ISO group was divided into two groups according to the time of BNP, adiponectin and cTnI determination: ISO I (n=6; 2 hours after ISO administration); ISO II (n=6; 4 hours after ISO administration). Blood for determination of parameters was taken from rat abdominal aorta. BNP, adiponectin and cTnI were determined by ELISA method. Data were statistically analysed by using SPSS version 13 computer program. P value less 0.05 was considered statistically significant. Blood BNP and adiponectin were lower at 2 hours after ISO administration in comparison with control group (p=0.004 for BNP and p=0.174 for adiponectin). Four hours after ISO administration, we have noted significant elevation of both parameters compared to ISO I group (p=0.004 for BNP; p=0.02 for adiponectin). Test of correlation have showed significant relation between their blood levels during experimental period (rho=0.577; p=0.01). BNP and adiponectin are not simple indicators of myocardial damage development. They have possible associated and additive effects in cardiovascular homeostasis regulation

Function of B-Cells and Insulin Resistance in Long-Standing Type 2 Diabetes Mellitus

Introduction. Every patient with type 2 diabetes mellitus secretes less insulin thannecessary for his/her level of insulin sensitivity, and many of them have some degreeof insulin resistance. The mix of insulin defi ciency and insulin resistance is differentfor each patient and, in any patient, it may vary during the course of the disease. Theaim of our study was to examine the degree o

Comparison of Trazodone, Diazepame and Dibenzepine Influences on Rat Brain Beta-Endorphins Content

The aim of our study was to establish the extent of influence of different psychotropic drugs to brain β-endorphins in experimental animals. The study was performed on albino Wistar rats (weight 250 g), treated with different psychoactive drugs. RIA technique was employed for quantification of brain β-endorphins. Brain β-endorphins were higher in experiment group treated with trazodone (929 pg/g ± 44,43; X±SD), and dibenzepine (906,63 pg/g ± 74,06), yet with lower brain content in rats treated with diazepame (841,55 pg/g ± 68,47), compared to brain β-endorphins content of control group treated with saline solution (0,95% NaCl) (873,5 pg/g ± 44,89). Significant differences were obtained comparing brain β-endorphins of trazodone vs. diaze-pame treated animals, with diazepame group having lower values (p<0,02). This study showed differences in changes of rat brain β-endorphins contents when different psy-choactive drugs are used. Therefore, we consider that β-endorphins could be used for evaluation of effects of psychoactive drugs, as a useful parameter in therapy with these psycho pharmaceuticals

C-Reactive Protein And Fibrinogen In Type 2 Diabetes Mellitus

Introduction. Chronic,low-grade infl ammation is important in the development andprogression of type 2 diabetes mellitus (T2DM). Indicators of increased infl ammatory activityinclude elevated values of circulating acute phase proteins like C-reactive protein (CRP) andfi brinogen. The aim of the study was to test sex-related differences in CRP and fi brinogenblood levels in T2DM patients.Patients and Methods. The cross-sectional study included 40 T2DM patients, bothsexes (19 males and 21 females), median age 70 (36-90) years. Patients were hospitalizedat the Clinic of Endocrinology, Clinical Center University of Sarajevo. The fasting glucoselevels, glycated haemoglobin, fi brinogen and CRP in the blood of T2DM patients weredetermined by standard laboratory methods. The data were analysed by statistical softwareSPSS 19.Results. The median values of CRP and fi brinogen in blood were not statistically differentbetween female and male T2DM patients, although values had tendency to be higher infemale patients [17.30 mg/L (3.40-61.35) vs. 9.60 mg/L (3.50-28.90); p=0.573]; [5.70 g/L(4.20-6.35) vs. 3.80 g/L (3.60-6.00); p=0.078]. A positive correlation between CRP andfi brinogen was found in samples from female T2DM patients (rho=0.606;p<0.01).Conclusion. Elevated CRP and fi brinogen indicate the presence of infl ammation in T2DMpatients. Female patients had higher values of both infl ammatory markers in blood incomparison to males, but we did not prove statistically signifi cant sex-related differences